Evaluation of Online Prospective DUR Programs in Community Pharmacy Practice
AUTHORS: Michelle Chui
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OBJECTIVE: To gain a better understanding of both the contribution that third-party Online Prospective Drug Utilization Review (OPDUR) programs make to prescription drug therapy, and the economic burden these programs impose on community pharmacy providers.
DESIGN: On-site data collection.
SETTING: 42 community pharmacies in Indiana.
MAIN OUTCOME MEASURES: The cost per overridden OPDUR alert and the cost per nonoverridden OPDUR alert can improve the safety and effectiveness of prescription drug care by alerting pharmacists to significant medication-related problems. However, questions have arisen in recent years regarding the benefits of OPDUR programs versus the costs these programs impose on pharmacies.
RESULTS: Across all third-party claims, 10.3% were associated with an OPDUR alert. Of alerts received at the pharmacy, 88.1 % were overridden by pharmacy personnel; the remaining 11.9% required an intervention by the pharmacist or technician. Of OPDUR alerts that were not overridden, interventions included consulting with the patient (55.4%), consulting the third-party payor (26.4%), and consulting the prescribing physician (17.6%). The typical OPDUR alert required 2.89 minutes of pharmacy personnel time, valued at $1.36. Overridden alerts were calculated to cost $1.20, while nonoverridden alerts cost $2.83. When the cost of resubmitting claims was factored in, the cost to pharmacies of not overriding an OPDUR alert was found to be $3.00.
CONCLUSIONS: Several recommendations can be made for improving OPDUR programs. First, the selectivity of OPDUR criteria should be increased through the adoption of more evidence-based criteria. Second, there should be greater coordination between OPDUR programs and in-store DUR systems to reduce redundancy. Third, the incremental costs to pharmacies of prescriptions associated with OPDUR alerts suggest that differential levels of payment may be needed to allow pharmacy organizations to dedicate the personnel time required to adequately respond to them.
KEYWORDS: Drug utilization review, Community pharmacy, Online prospective drug utilization review, third-party prescription benefit plans